The population of the United States, as in most developed nations, is aging and is doing so at an increasing rate. This change in demographics is having a profound affect on the nation's healthcare delivery system and the related public costs. Long-term care for the elderly is a major component of this cost trend. The strong predilection of most of the elderly, and their families, is to maintain the independence afforded by long-term care delivery in the home rather than in the institutionalized setting. Properly managed home care can also have a significant effect on controlling or even reducing the cost of long-term elderly care. However, in order to deliver this care cost-effectively a technology-based infrastructure optimized for this purpose will be required. One means of achieving this goal is to provide low-cost technology that can monitor, maintain and extend the physical mobility, and thereby the independence, of the elderly within the home. It has been demonstrated that an at-home physical therapy program consisting primarily of 10-15 minutes of balance, exercise and strength training can slow the functional decline among the elderly including the most physically frail and aged persons. There is also solid evidence that a regular regiment of structured exercise or physical therapy can improve measures of mobility and fitness in older adults, particularly strength, aerobic capacity, improvements in gait and balance, as well as other long-term functional benefits such as decreased pain symptoms for those elderly with Arthritis and promotion of bone mineral density and thereby decreased fracture risk. There is also evidence that it may counteract key risk factors for falls, such as poor balance, and consequently reduce the risk of falling in elderly. Fall-related injuries among older adults, especially among older women, are associated with substantial annual economic costs (>$19 billion) and are borne by individuals, society, and the medical care system. Unfortunately, the same research that has identified exercise and physical therapy as important interventions has also identified practical and cost-effective limitations that constrain dissemination of this type f intervention when using only conventional solutions. We propose developing a portable technology solution that will be capable of not only monitoring and measuring the elderly user's activities but also monitor and measure their physiological response to a series of programmed exercise tutorials and deliver this data to clinicians and researchers via a secure network. In addition to providing significant direct health benefits to the elderly users and their caregivers, this system will also provide researchers and clinicians with an potentially important clinical and research platform. This system will also be capable of promoting social interaction by providing the ability for third-party developers to deliver other applications that engage elderly users in social networking activities. PUBLIC HEALTH RELEVANCE: At-home physical therapy and exercise programs can slow the functional decline among the elderly resulting in significant benefits to them and their caregivers, while also reducing the cost of long-term care. We propose developing a system of software and hardware that will promote the low-cost delivery of these types of programs, as well as provide an important future research platform.